Diabetes mellitus (DM) significantly impacts surgical outcomes, particularly in cardiac surgery, due to increased infection risks and mortality rates. Hyperglycemia, whether due to stress or underlying disease, exacerbates these risks. The DOCS study aimed to evaluate a new screening model involving glycated hemoglobin (A1c) testing and specialized DM management to mitigate these risks.
Methods:
The study included 1146 patients undergoing cardiac surgery at UPMC | IRCCS ISMETT. Patients were divided into two groups: Screen+ (tested post-July 2021) and Screen− (pre-July 2021). Propensity score matching ensured comparable groups for analysis. A1c testing identified undiagnosed DM and guided glycemic management throughout hospitalization.
Results:
The Screen+ group (n=573) demonstrated significantly lower perioperative infections (11%) compared to the Screen− group (18%, p=0.003), primarily surgical wound infections. No significant difference was found in 30-day mortality. A1c testing identified 12% of patients with previously undiagnosed DM and optimized glycemic control.
Discussion:
Systematic A1c screening at admission allowed early identification and management of diabetes, reducing infectious complications without impacting short-term mortality. Despite challenges and study limitations, including regional endemic factors and short follow-up, the study supports routine A1c screening for improved surgical outcomes.
Conclusion:
Implementing systematic A1c screening and specialized DM management in cardiac surgery patients enhances risk stratification, reduces infectious complications, and identifies undiagnosed diabetes. This approach warrants further study to assess long-term outcomes and healthcare cost implications.
Implications:
The findings advocate for integrating specialized diabetes care in surgical settings to optimize patient outcomes and potentially reduce healthcare costs associated with postoperative complications.
Ethical Considerations:
The study adhered to ethical standards, including patient consent and compliance with the Declaration of Helsinki, ensuring patient welfare in research practices.
Future Directions:
Future research should focus on long-term mortality outcomes and cost-effectiveness of systematic diabetes screening protocols in diverse healthcare settings.
This structured approach to reporting highlights the significance of proactive glycemic management in improving surgical outcomes, emphasizing its potential benefits across healthcare systems.
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